When we tallied the results from our annual salary survey, ADVANCE readers painted a very positive picture about their profession. Overall, salaries rise when nurses earn academic degrees - from BSN to MSN and doctorates - and when RNs achieve national certification in their specialty. As RNs gain more experience in their profession, they are rewarded with higher pay.
Clinical Advancement Programs
Many hospitals have developed sophisticated clinical advancement programs that provide financial recognition for professional achievements. Catherine K. Madigan, MSN, RN, NEA-BC, associate chief nursing officer at UNC Hospitals, Chapel Hill, NC, described how her organization's mature program played a role in UNC's first Magnet designation in November 2010. "We tied advancement to national certification in a nursing specialty, BSN education, attendance at meetings, involvement in our shared governance structure and other professional accomplishments," she said.
Nursing salaries at UNC Hospitals are linked to clinical advancement. "We expect nurses to function in an advanced capacity as they move up the ladder, and provide significant remuneration for nurses who meet those expectations," Madigan said. "A nurse who moves from a clinical nurse II to a CN III role makes $4,000 more, and advancement to CN IV brings another $5,000 in salary. The CN IV is not a management position, but it is a leadership role, and we educate and mentor those nurses so they can continue to grow as leaders at the bedside."
Rewarding Bedside Excellence
The Professional Excellence Nursing Council at Mount Auburn Hospital, Cambridge, MA, just rolled out a new clinical advancement program designed to encourage excellence at the bedside.
"For years, we had a system in place with categories that recognized participation on committees and other professional activities, but it didn't reflect elements of bedside care as much as the council would like," said Deborah Baker, MBA, BSN, RN, vice president of patient care services and chief nurse executive. "We learned from our [National Database of Nursing Quality Indicators] survey results that there was an opportunity to increase our percentage of certified nurses to stay consistent with other hospitals across the country. When we shared the data with our council, we agreed that our patients deserve no less."
Council members looked at clinical advancement programs across the country.
"From there, they developed a picture of what a professional nurse at Mount Auburn looks like," Baker explained. "Built in to the program are advanced degrees and/or certification. Nurses who achieve advanced clinical level I or II get additional compensation, but I would hope nurses do it for their sense of accomplishment and professionalism rather than just for the money."
Mount Auburn nurses also receive salary adjustments each year based on market factors, along with added dollars for their years of experience.
Debbie White, MSN, MSA, RN, ACNS-BC, NEA-BC, vice president and chief nursing officer at Saint Luke's Hospital, Kansas City, MO, described how her facility rewards professional accomplishments. "We changed our clinical ladder several years ago from a task-focused system to more of a behavioral approach," she said. "We expect nurses to demonstrate that they've impacted nursing practice and outcomes, rather than just attending meetings."
White explained the rationale for rewarding national certification in a nursing specialty. "Nurses who are nationally certified carry a body of knowledge that directly impacts patient outcomes. Patent outcomes are a large part of advancing on the clinical ladder," she noted. "Moving up the four levels of our ladder provides a substantial annual increase in the hourly rate."
Karen Hanson, RN-C, CHCR, director of talent acquisition and retention at Hackensack University Medical Center, Hackensack, NJ, shared a similar picture. "We've always recognized national certification for nurses, giving them an incentive payment when they're first certified and then each time they renew their certification," she said. "We also provide additional compensation for a BSN degree that's built right into the base pay."
Nurses who want to advance along the medical center's four-level clinical ladder prepare portfolios for review by their nurse managers and the professional practice nursing council. "The portfolios reflect nursing achievements, such as a quality improvement project or nursing research, and match the criteria for each level on the ladder," Hanson said.
Experience & Specialization
Several nurse leaders outlined salary guidelines that reward longevity and experience, rather than the type of nursing unit where the RN is employed.
"We have abolished an old pay structure that compensated nurses differently based on where they worked clinically, and adopted a more simplified compensation structure," said Carol Bradley, senior vice president and chief nursing officer at Legacy Health, Portland, OR. "We want to ensure that our nurses are being recognized for their clinical experience and contributions regardless where they work within Legacy."
Lorie Shoemaker, DHA, MSN, RN, NEA-BC, chief nurse executive at Palomar Pomerado Health (PPH), Escondido, CA, shared a similar perspective.
"Our nurses are organized for the purpose of collective bargaining by the California Nurse Association (CNA)," she said. "We used to have a pay range, say $30 to $40, and would hire nurses based on their years of experience. We'd then reward them with merit-based pay increases anywhere from 0 and 5 percent. Working with CNA, we went to a step system that rewards experience and longevity within the organization. We don't pay differentials to nurses in specialty units."
Our interactive state-by-state map above includes each state's salary data.
Nurse leaders continue to view the BSN degree as an important component of nursing practice. For example, PPH near San Diego supplements the step system with a Performance Enhancement Program, or PEP.
"Nurses can earn PEP points for national certification in their specialty, for earning a BSN or MSN, for professional activities like presenting case studies, and for extracurricular activities, such as volunteering at school programs or flu shot clinics," Shoemaker stated. "They can earn $700 to $3,000 annually by accumulating PEP points."
At Legacy Health, Bradley and her team continue to weigh the pros and cons of restricting hiring to BSN-prepared nurses.
"But we have strong relationships with both ADN and BSN programs in the area. Over 1,200 nursing students have clinical experiences at Legacy Health each year, and those relationships are important to us," she explained. "However, we do want our nursing workforce to be BSN-prepared, so we have an expectation that any ADN new graduates will earn their BSN within 5 years."
Job Market Bright Spots
Some nurse leaders reported a firming up in the job market, while others are still dealing with the status quo.
"We've always hired new grads, bringing them in when they're new, training them and growing them within the organization," Hanson said. "The group of nurses who transitioned from per diem or part-time, or returned from early retirement when the economy changed is still here with us as well."
UNC Hospitals is in a unique position because of its continued expansion, Madigan noted.
"We always have some nursing jobs, including positions within our Flex Team per diem group," she said. "Although the job market may be opening up a little, it's not as open as it once was. There's still not a good market for new graduate nurses, in part because the nurses who came back from having children or from early retirement are still here."
The job market is still tight in the Pacific Northwest.
"Hospital salaries have softened considerably, so this has slowed the typical demand for hiring," Bradley said. "We have made a focused effort to hire new graduate nurses because we are looking at the long-term workforce needs of Legacy Health. Despite the current environment, [we] made a commitment to begin a residency program for new graduate RNs."
Noting the job market for new grads has been tight in San Diego County over the past couple of years, Shoemaker highlighted a program that's opening up some positions.
"We recently received a $250,000 grant to develop a program with California State University San Marcos," she said. "Senior baccalaureate nursing students take an advanced med/surg, critical care or OB course at the college and then work part-time at PPH to practice their skills. They're guaranteed a job when they graduate."
For new grads seeking jobs in Kansas City, White offered a glimmer of hope. "For a couple of years, we've reduced the number of new grads we hire. However, in May 2010, we moved back to the same number as in previous years," she said. "The job market is not like it was years ago, but it is getting better."
Sandy Keefe is a frequent contributor to ADVANCE.
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